The iPads large screen and interactive interface make it an ideal platform for medical imaging.

NeuroRad by RadLynx LLC is a clinical neuroradiology reference designed for a range of healthcare professionals involved in neurological imaging of the brain.

Written and designed by an American Board of Radiology certified Neuroradiologist, NeuroRad aims to improve understanding of neurological imaging and associated pathologies.

We have previously reviewed the NeuroRad Mini for the iPhone, and this is the iPad counterpart.

The main feature of this app is the interactive imaging atlases. This is split into a number of sections; Cross Sectional MRI Anatomy, Vascular territories, MR Angiography (both arterial and venous) and CT Angiography.

All three views (Saggital, Coronal and Axial) are accessible complete with labels. Navigation through the different parts is innovative and involves pinch-to-zoom multitouch gestures which scroll through the different anatomical slices. The images are high resolution and clearly labelled. Unfortunately, there was no way to turn off the labels in this section in order to test oneself.

The Vascular territory atlas covers both arterial and venous supply and is an excellent resource navigated in a similar fashion to the cross sectional atlas. A clear key illustrates the different areas of the brain supplied by each artery-key for any neurosurgeon. Labels are also included here to develop recognition of key structures

The MR Angiography section covers both the arterial and venous system. Each view has a multitude of labels which consolidates anatomical knowledge. There are also a range of views including ‘Tumble’ and ‘Spin’ which aim to improve 3-dimensional understanding.

The CT angiography also covers the three main views (Saggital, Axial and Coronal) and both arterial and venous systems. It is useful that these images are highlighted so that the path of the vessels can be visualised.

The other major section of NeuroRad for iPad is a detailed weblink and reference section. There are a decent range of weblinks covering a range of aspects related to neuroradiology from MRI images to clinical sites including journals and professional associations. This collection of weblinks (which open in Safari) is a good resource for residents and interns looking for further information.

The reference section contains some excellent information related to pathologies which may be seen on a scan. These are presented as a list of differential diagnoses which are extensive. There is very little pathophysiology explanation although references are provided for the interested resident who is looking for further reading.

Price:

• $9.99 (although currently on sale as new content is added and updated)

Likes:

• Detailed, labelled radiology atlas covering the three main views
• Excellent visualization of the vessels in the brain using both MR and CT Angiography
• Detailed differential diagnoses for a range of abnormalities seen on radiograms
• Collection of weblinks

Dislikes:

• No ability to share information/screenshots via email/social media
• No ability to turn the labels on/off in order to test oneself

Overall Rating:

• NeuroRad for iPad is a fantastic application for radiologist residents with an excellent neuroradiology atlas
• Has a range of uses for healthcare professionals ranging from student to resident
• An all-round excellent application for those interested in neurological imaging

iTunes link

by: Brian Chau, MS3

Being able to recognize key anatomical landmarks on radiological imagery is important for any medical student or clinician.

NeuroRad Mini is an app available through iTunes for users looking for a mobile reference and review guide to brain images.

NeuroRad Mini, from developer RadLynx, is a clinical MRI brain atlas for iOS devices. It features coronal, sagittal, and axial views of the brain. These are all labeled, allowing for easy viewing and review of important anatomical locations and relationships.

Designed by a senior member of the American Society of Neuroradiology, NeuroRad Mini is a more limited version of the iPad-only app, NeuroRad, also from RadLynx. NeuroRad Mini is designed to be a quick-reference guide to MRI views of the brain, while the iPad version offers more features, due to the limitations of the screen size and processing power of the iPod Touch and iPhone platforms.

I was impressed by how easy it was to navigate NeuroRad Mini on a small device such as the iPod Touch. Everything in the app loaded quickly, with little noticeable lag. Image scrolling through different cross-sectional views are fluid and accomplished by using the Multitouch contols. I could either swipe once to change to a single new view, or enable continuous image changes by dragging two fingers on screen. Just swiping to view the next image seemed to be the best way to view images through NeuroRad Mini.

NeuroRad Mini also allows the user to view labeled images of the various neuro cross-sections. This option is very useful, especially in a clinical educational setting. A simple upward swipe on the screen will turn off labels, while swiping down turns them on. The pointers to each brain region are easy to follow and visualize, even on the smaller screen of the iPod Touch. To zoom in, double-tapping the brain or tapping the magnifier glass will do the trick. I did notice that zoomed in images weren’t quite as detailed as many would like, but they are certainly still useful for learning and reference.

While some medical apps require an active Internet connection to pull images and information, NeuroRad Mini offers almost all of its content locally. This is a huge benefit, as not every user has access to a network data plan or wireless connection 24/7. Even the basic help and support pages on the app do not require active network access. Finally, for users desiring more information or assistance with NeuroRad Mini, the developer’s website offers a fairly comprehensive FAQ and user guide.

Price and technicals:

• NeuroRad Mini is available for $9.99, through iTunes
• This app requires iOS 4.3 or later and runs on the iPod Touch, iPhone and iPad
• There is also a larger version named NeuroRad available for the iPad exclusively.

Likes:

• Wonderful review of brain anatomy seen through MRI imagery
• Large selection of high-quality neuro MRI images
• Smooth navigation and superb layout
• Excellent clinical relevance
• Great customer support, both online and off

Dislikes:

• Users of older iOS devices will not be able to run NeuroRad Mini
• Limited to MRI imagery

Conclusion:

• NeuroRad Mini is a solid choice for a brain atlas utilizing MRI imagery
• It’s a must-have for any user interested in better understanding the anatomic layout of the brain in a clinical setting.

Links:

Developer
iTunes

Harrison’s Principles of Internal Medicine is regarded as one of the premier textbooks for physicians through to medical students.

Primarily aimed at internists, it is accessible to medical professionals at all levels with its fundamental clinical medicine coupled with an explanation of underlying pathophysiology. Now in its 18th edition, it is without doubt one of the most recognizable and useful resources to practicing physicians today.

iMedicalApps has previously reviewed Harrison’s Manual of Internal Medicine for the iPhone here but today we take an in-depth look at the full Principles of Internal Medicine for iPad as it has now arrived via the Inkling platform. Inkling is renowned for taking classic textbooks and ‘reinventing’ them with a range of interactive features and media.

By their own admission, Harrison’s has been the most ambitious project to date and has taken over a year to complete the transformation to the iPad.

This review will not focus on the content of the book as most people will have experienced Harrison’s at some point during their medical career. Suffice to say Harrison’s Principles of Internal Medicine continues to set the standard as the pinnacle of current medical knowledge and practice, offering the definitive review of disease mechanisms and management.

As such, this review will focus on the overall Inkling platform and features which accompany this iPad version of Harrison’s Principles of Internal Medicine.

The first important thing to note about the Harrison’s textbook is its size. The paper version weighs in at 2,800 pages and this translates to approximately 2GB of space on your iPad. However all 397 Chapters and 57 eChapters are stored locally on your device removing the need for an internet connection.

Launching the textbook within Inkling brings the user to a familiar user interface.

All Inkling titles are designed and built upon the same platform and utilize the same structure as seen in other titles such as Essentials of Clinical Anatomy and Ganong’s Physiology.

Initially, the user is presented with a (very long) list of chapters. Each group of chapters is collected under a ‘Part’ but unfortunately there is no way to expand or hide these parts meaning that you have to scroll through every chapter until you find the one you want. I feel Inkling may have missed a trick here as the closest feature that has this function is the actual contents page (see screenshot) which breaks the book up into its various ‘parts’. This has more to do with the structure of the book which splits each section into chapters but it does mean finding the required chapter can be more challenging than it should be.

However, once a chapter has been selected, navigation throughout the text is simple and straightforward. The arrows in the bottom left of the toolbar quickly jump between sections.

Navigating within a section was sometimes more challenging than desired. While there was some inertial scrolling, I found that this was not always enough to quickly scroll through the sections in each chapter. This was only really apparent on the larger chapters which contained vast amounts of information. In general, though, I did not have any problems interacting with the book. I was pleasantly surprised by the speed at which different sections and images were loaded.

One aspect of this title which the Inkling platform does not cope particularly well with is the sheer size and detail of many sections. Although there are options to change the text size, I felt that sometimes the text was too big (even on the smallest setting) and as a result actually became harder to read.

An example is shown in the screenshot below where one paragraph takes up the entire page which is difficult to read. Page fidelity with the paper version is maintained and marked off at the start of each chapter.

Integrating media into textbooks has always been an Inkling strong point and they do not disappoint with Harrison’s. There is a wealth of images, tables, slideshows, videos and more, all fully integrated and linked to within the text.

Tapping on a table or image will cause it to slide in on a new page so that you can purely concentrate on the information while a quick flick will cause it to slide away. I found I often used the search function to navigate as it was often quicker and easier than scrolling through numerous detailed chapters. I liked the fact that all information related to treatment and management had been highlighted which made finding this essential information quick and easy.

One of the nice things about using the Inkling platform is that thought that has gone into the little details. For example, including an inbuilt dictionary to define words or including the option to search by content type. One feature I hadn’t noticed before was the inclusion of a ‘back’ button when a hyperlink takes you between chapters.

The inbuilt search function is highly effective and useful tools such as bookmarks, highlighting, and basic annotation make customizing the textbook easy. While the annotation tools are not as comprehensive as those seen in PDF management apps, they are generally suitable for most uses.

Having used this book for a number of weeks now, I think it is an excellent title and believe that Inkling have done a fantastic job transferring this title to the iPad. The rich text and media go a long way to making Harrison’s more accessible to medical professionals and students alike. Time will tell if the inbuilt social features allowing users to share notes takes off.

Price:

• $199 although there is currently a 20% discount code posted in the forum

Likes

• All content stored locally
• Treatment information clearly highlighted including algorithms
• The range of interactive features that have become an integral part of Inkling titles
• Having each chapter split into sections making it easier to find information

Dislikes/Future updates I’d like to see

• More inertial scrolling
• Expandable sections and chapters to make navigating 350+ chapters easier
• I would like to see the option of a smaller text size whilst reading the main sections
• Constantly having to scroll whilst reading which can become cumbersome

Overall Rating

• Harrison’s Principle of Internal Medicine is another excellent title from Inkling
• One or two navigation issues do not take away from the fact this is the only iPad optimized version of this essential clinical reference text
• Medical professionals who purchase this text will know they carry one of the most extensive medical resources in a highly accessible format on a device no larger than a notepad.

iTunes link:
Inkling Store:

The medical education learning environment is rapidly evolving with the development of mobile technology, high speed internet and the improved connectivity with learning institutions.

These developments have enabled huge growth in less traditional learning tools such as online textbooks, anatomy videos, video lectures and a whole host of other resources. Podmedics is a site designed by UK foundation doctor Ed Wallitt and contains a vast range of podcasts for medical students and junior doctors alike.

Podmedics is a website, which means that it is accessible from home computers, iOS devices, Android devices etc. In fact, PodMedics should be accessible from most modern devices with an internet connection.

Once you have registered on the site, it is possible to search all podcasts, view all lectures or navigate by specialty. There is an excellent range of specialties available ranging from Cardiology to Rheumatology and extra sections dedicated to Surgery, Clinical Specialties and Clinical Sciences.

In total there are over 150 different podcasts available.

There is also an excellent set of notes for Surgery and Clinical Pharmacology which are at ideal level for medical students on their rotations (please note that the guidelines contained are for the UK and may differ elsewhere).

The podcasts are an excellent learning resource and offer an alternative style to those who prefer audio-visual learning rather than pure text. Each podcast has an associated slideshow and is narrated clearly. Each podcast varies in length between 10mins and 50mins depending on the subject being covered.

The level of detail in each is appropriate for advanced medical students and junior doctors. Overall I found the podcasts engaging and informative and a great way to fill a few moments of spare time or learn more about a patient I had recently seen.

Each podcast has attractive animations which showcase the essential learning points for each topic. It is an annoyance, though, that there is no native app for Podmedics. While an internet connection is required in order to view the podcasts, it is also possible to download the audio or video from the website to your computer or mobile device for offline watching. This is a useful workaround but not ideal or straightforward for busy clinicians.

Podmedics is soon to be updated and will include a brand new interface, new notes system with pdf export, recommended order to watch podcasts in, and a podcast tracking system to track which podcasts each user has watched.

Price:

• Registration on the Podmedics website is free and allows 7 days access
• Upgrading to a full subscription costs £30 per year (Approx $50)

Likes:

• Wide selection of podcasts available
• Playable on a range of devices

Dislikes:

• Podcasts require an active internet connection/not straightforward to watch offline
• No native app

Overall Rating:

• Podmedics is a superb resource for medical students and junior doctors alike
• The wide selection of topics, appropriate level of content and variation in length means the podcasts can be used for a quick reminder or a more detailed discussion of a particular topic

Site

There are few, if any, large corporations that use mobile technology to engage their customers as effectively as Louisville, KY-based health insurer Humana.

The company’s Games 4 Health program is among the most innovative mobile health programs anywhere and the projects like B-Cycle are revolutionizing bike sharing and incentivizing healthy lifestyles.

I recently had a chance to hear Julie Kling, head of mobile strategy for Humana, outline the company’s strategy during a panel discussion at the December mHealth Summit in Washington, DC. I was very impressed by her understanding of how mobile technology can improve customer engagement and provide information to patients at critical points in the care delivery process. What was clear from the panel is that other large health plans and wellness organizations could stand to learn a great deal from Humana.

I was able to interview Julie Kling following the mHealth Summit to gain some insights on how Humana develops its mobile apps, what specific problems they hope to solve for their members with their mobile products and services, and how her experience as a nurse helps inform her vision for keeping Humana on the cutting edge of mHealth innovation.

See the transcript of my discussion with Julie Kling below.

BTE: How does your background as a nurse effect your perspective and inform your strategy decisions at Humana?

Julie Kling: I think I have a real world experience that helps me to understand what the needs are from both a patients perspective as well as the members here at Humana. I understand what the challenges are in managing a chronic illness and its impact on a persons well-being and all of the factors that go into that individuals health.

Humana has this well-being strategy which not only takes into account the patients health, including emotional, physical and spiritual, but also focuses on belonging, security and purpose, and as a nurse that all makes a lot of sense to me in terms of helping to support people managing their life and lifestyle. That is what we are really trying to do by building a mobile capability that really addresses the needs that an individual has and helps to provide those supportive capabilities.

BTE: As a consumer, the first thing that springs to mind when I think of health insurance is cost. At Humana do you use mobile to give your members tools to help manage or even lower the cost of their plan?

Julie Kling: I think there are quite a few components or features that are there to help people make better health care decisions that may impact their financial accountability for their health care. One of those I mentioned in my presentation at the mHealth Summit allows users to see what the costs are for a particular drug their doctor is about to prescribe them.

I had a very personal experience with this when I had a doctor prescribing me a drug that cost $140/month, and I went and did a simple search on our website and was able to find a $4/month alternative, and if I had been able to do that while I was at the doctor’s office it certainly would have helped me and its part of the reason why we want to have that feature available to our members.

We did some consumer research and we found our members were primarily interested in tools that can help them manage their costs, so you will see that type of information featured in our mobile apps, for example members can view their health savings account balance and immediately upon using their health savings account they will see the transaction in their mobile app so they can see precisely how much they have available to use to cover prescriptions or other services.

Our members can use the app to find out how close they are to meeting their deductible. In fact, one member sent us a note via the iPhone market to tell us that they were going in for surgery at a hospital and the hospital had asked them to pay $2400 dollars up front before the surgery and they were able to show that they had met their deductible just by using the app so they weren’t required to pay the $2400 before their surgery. These are just a few examples of how people can really manage the financial component of their health care by using the MyHumana app.

BTE: How do you build the apps, do you have an internal team of developers at Humana or do you partner with other companies on different projects?

Julie Kling: We actually do build internally. Our MyHumana app is built internally, we have a couple technical teams that focus exclusively on mobile, but that doesn’t mean we don’t partner on occasion. If its something that we don’t consider a core competency, which for us is our claims rescinding, our birth benefits and health benefits, but there are some things where we will partner. For example, we partnered with other groups to help us build our health games and Humana Fit app. We really look at every situation and determine whether or not its something we want to deliver quickly, and do we have the core  competency to achieve that. So its truly a combination of both strategies.

BTE: One thing I encounter a lot are entrepreneurs with great products that would be great potential partners for Humana, but they don’t know how to engage you guys, so my question is how do they engage Humana for a special partnership in the areas that don’t fit into your core competencies? How do they know what particular expertise or technologies Humana is in need of?

Julie Kling: We actually have a strategic vendor management process and they can reach out to me and I can connect them into that process and let them know how we are doing and what our roadmap looks like and whether or not we really have that need. The needs we have a really driven by our overarching strategy and goals, so we have a process that brings people in. I can tell you, I get calls, emails and invitations every day from potential partners, but sometimes it takes time and effort to figure out where there is alignment and how that relates to the needs we have.

BTE: What is the next step in Humana’s mobile strategy? Do you have any new products in the pipeline or near-term goals?

Julie Kling: I think that as we continue to shift toward becoming a well-being organization you will see more activity from us on that front. One example is a company we recently launched called Vitality, which is a well-being and rewards program, and we will be seeing more and more mobile capabilities that relate to Humana Vitality, help people make good food choices and exercising. We want to move further into managing chronic illness and are going to be testing out biometric monitoring so we can have real data we can use to help them manage their conditions and work with their doctor to manage their conditions, which is really exciting and unique.

You will see us moving further into the sales cycle with the launch of a feature called “click to speak to an agent” which allows potential members to go to our mobile site and click on a button which connects them to an agent and enables them to see if they want to purchase any of Humana’s products or services. We are also going to start enabling potential members to get a quote through our mobile site by answering a series of questions to determine precisely what the costs would be for one or more of the products we offer, be it medical, or vision, or dental, all the information needed to make informed decisions about their coverage.

BTE: How do you get potential customers to visit your mobile site to get quoted for Humana’s services?

Julie Kling: We are doing a couple of things. First, we see a lot of people come to our site directly, many of whom are not Humana members but are just interested in finding out whether Humana’s products and services are potentially valuable and what they would cost. We are also testing out a text messaging campaign where we will do radio ads and those radio adds will allow listeners to get a short code which they can text in to get additional information and will be able to talk to a representative and purchase our insurance products. So we don’t really buy search engine ads, but we do use radio ads and we do see a lot of direct traffic.

BTE: So you guys have both native apps for all major platforms as well as an HTML5-based mobile web app?

Julie Kling: We do have an HTML5 mobile website, and I would describe what we offer as hybrid apps or wrapper apps where we use the same capabilities you find on the mobile website and we have enhanced it with some of the native capabilities you have on iOS and Android. You can think of it as a mobile frame that goes around the mobile website that has the same HTML5 capabilities which enables us to quickly deliver what we have on the mobile website to an app, which is a great way to ensure you are being efficient about your development.

A number of recent surveys have indicated that the Apple iPad is the number one choice for healthcare professionals when it comes to choosing a tablet.

This is hardly surprising given the head start the iPad has had compared to its competitors (read more here) and the significant development that has gone into medical apps for the iOS platform.

This article will attempt to help decide which particular iPad is the best choice for a healthcare professional who wants to use it as part of their daily workflow.

The choices available from the Apple Store at the time of writing are as follows:

• iPad 2 3G/Wi-Fi 16GB
• iPad 2 3G/Wi-Fi 32GB
• iPad 2 3G/Wi-Fi 64GB

This article will not consider the color of each device as that is a purely aesthetic choice. When it comes to purchasing an iPad, there are three main considerations, each of which will be addressed in turn:

• Processing hardware
• Storage space
• Connectivity

Processing hardware

As tablets become more powerful, they gain the ability to run more demanding applications. This means that they are generally faster, better at multitasking and will be suitable for future software developments. The iPad 2 was a large hardware upgrade from the original iPad with an enhanced processor, more memory and two cameras amongst other features.

Due to this, the iPad 2 is recommended over the original iPad.

Storage space

The iPad 2 is available in three different sizes, 16GB, 32GB and 64GB. The average app size for iPad apps is often larger than that of iPhone apps. One of the main functions of the iPad for medical professionals is storage and reading of medical literature. It is very easy to store large numbers of PDFs and presentations using apps such as PDF Expert/GoodReader. Apps such as Dropbox store the majority of documents online, however, they still require some local storage in order to display the files.

Another storage aspect worth considering is the rise of eTextbooks. Companies such as Inkling release excellent versions of core texts, though these can take up significant amounts of space– e.g. Inkling’s version of Harissons Principles of Internal Medicine is an amazing resource however it does take 3.4GB of space.

One final consideration when it comes to storage is accessibility. This will be discussed in greater detail below. Essentially, if your hospital or workplace has excellent connectivity, the greater you will be able to rely on cloud based storage services such as Dropbox.

If your hospital has a number of deadspots or you are based in the community then chances are you will want to make greater use of local storage to ensure you have access to all your documents regardless of internet connectivity.

On the basis of this, the 32GB model is regarded as the minimum size for healthcare professionals. The 16GB model does not have enough local storage on it for it to function effectively and users with this model are likely to find themselves running out of space in the future. In an ideal world, the 64GB model with its significant amount of storage would be the ideal choice, however, this does come at a cost. Users who are keen to store lots of documents locally and other media such as videos and photos may find that this model suits their needs better.

Although not strictly medical, this info graphic from gizmodo helps illustrate the different storage sizes available.

Connectivity

The final consideration when purchasing a new iPad is connectivity. All iPads are supplied with Wi-Fi as standard but a Wi-Fi + 3G model is also available. 3G keeps you connected to the internet even when Wi-Fi isn’t available and uses the same signals your mobile phone uses. It’s available without a contract and service is sold separately. Interestingly, Wi-Fi + 3G iPads include a GPS locator which the Wi-Fi only iPads do not.

Connectivity is an integral part of many medical apps which often store information online and download it as and when required. Similarly many iPads are used to input data into EMRs which also require internet connectivity. This is vital and therefore the Wi-Fi + 3G model is recommended for healthcare professionals. There is no need to purchase a contract for 3G data if there is Wi-Fi available, though it is useful to be able to access 3G if required.

Overall Rating

Having considered each of these three main points, it is clear that the iPad recommended for healthcare professionals is the 32GB Wi-Fi + 3G model. The 16GB model is not recommended on the basis of storage whilst the 64GB is not recommended on the basis of cost. 3G connectivity is essential to ensure that internet access is maintained in case there are deadspots in the hospital. The 32GB model should be more than adequate for the majority of users’ needs.

When it comes to anatomy apps on the iPhone, users are spoilt for choice. There is a huge range available ranging from flashcards to reference textbooks and more.

In a fantastic development, Visible Body has been released on the iPhone. When we reviewed Visible Body for the iPad, we were greatly impressed by its combination of anatomical detail, clinical correlations and novel approach to anatomy noting ” Visible Body is a dazzling demonstration of human anatomy”.

With the release of Visible Body for iPhone, it will be interesting to see if it is possible to maintain the high standards previously set.

Launching Visible Body takes a few moments and presents the user with a contents screen. Here it is possible to select the particular system and then a particular viewpoint e.g. Muscular System and then Upper Arm.

There is an excellent range of systems covered as shown in the screenshots.

There are 270 different views in total spread over 11 systems. It is also possible to change the gender of the 3D model while selecting a particular view. This impressive range of views makes up for the fact that there is no viewpoint of the complete 3D model. This omission does not impact upon what is a complete range of anatomical viewpoints.

Selecting a view and navigating through the menus is intuitive and simple, leading to the real strength of the application-the 3D model. Visible Body for iPhone makes excellent use of multitouch gestures to manipulate the model including pinch to zoom, rotate and pan. The controls are intuitive and it is very easy to learn how to quickly manipulate the model into a desired position.

Tapping on a structure highlights the structure and names it in a box at the top of the screen. There is a small plus symbol next to the name which can be used to show which system and the location of the selected structure. There are also options to show, hide or fade the structure which enables the user to understand the complex interplay between various anatomical structures.

At the bottom of the screen is a number of other options including Views, Definition, Actions, Help and Search. The Views button returns the user to the original selection of anatomical views whilst the Definition tab provides useful information related to the selected structure. The Actions tab offers a range of other view options such as the ability to refresh the model, change gender etc. Finally, the Help and Search tabs are self-explanatory.

The search function is particularly effective; typing a keyword into the search form brings up a list of structures. If the structure isn’t in the current model, one can add it. If it is in the model, one can select it or center the view on the structure. However, the search function does suffer from one or two drawbacks.

First, there can be a noticeable delay while searching and second, the search result will only be displayed with the current model. For example if you are looking at a nervous system view and add an artery it can be challenging to understand the anatomy. (See below for a screenshot of the left coronary artery added to a view of the nerves of the head and neck.)

Price:

• $9.99

Likes:

• Gorgeous, detailed 3D anatomical model
• Clever use of multitouch gestures to adjust 3D model
• Accompanying text contains a high level of detail

Dislikes:

• Memory intensive so therefore subject to occasional slowdowns and unresponsive (as such this is only recommended for users of iPhone 4/4S)
• Search function displays search results in current model which is not always appropriate

Overall Rating:

• Visible Body for iPhone is just as impressive as the iPad version
• The level of anatomical detail is very high and nothing major has been lost in the transition to the smaller device
• At $9.99, Visible Body is a steal when compared to other decent anatomy apps available for the iPhone
• Visible Body has many uses from patient education, to medical students and medical educators. Hands down one of, if not the best, anatomy app available for the iPhone.

iTunes link

mHealth Research Daily, with Tim Bredrup

Common immediate life-threatening conditions such as apnea (APN) and pneumothorax (PTX) can be easily ruled out by performing an ultrasound that visualizes a respiratory motion known as lung sliding (LS). Institutions from around the world collaborated on a study that assessed how economically and practically this information could be obtained remotely over a cellular network.

Remote expert sonographers directed remote providers with little to no ultrasound experience on how to obtain the images needed to rule out APN and PTX. Through the use of handheld ultrasound machines streaming images via Skype services on an iPhone, examinations were conducted between a series of remote sites and a base station. Sites included two remote on-mountain sites, a small airplane in flight, and a Calgary household, with base sites located in Pisa, Rome, Philadelphia, and Calgary.

In all lung fields (20/20) on all occasions, LS could easily and quickly be seen. Furthermore, the respiratory motion was easily corroborated and documented through capture of color-power Doppler and M-mode images. Other ultrasound applications such as the Focused Assessment with Sonography for Trauma examination, vascular anatomy, and a fetal wellness assessment were also demonstrated.

The study concluded that the emergent exclusion of APN and PTX can be immediately accomplished by a remote expert economically linked to almost any responder over cellular networks. It’s been suggested that further work should explore the range of other physiologic functions and anatomy that could be so remotely assessed.

As technology continues to grow in exponential fashion, it is likely that more applications of this concept will emerge going forward and the practice of telementoring will become more common place given the many advantages it can provide.

Authors:McBeth PB, Crawford I, Blaivas M, Hamilton T, Musselwhite K, Panebianco N, Melniker L, Ball CG, Gargani L, Gherdovich C, Kirkpatrick AW.

Institutions: From the Departments of Surgery (P.B.M., T.H., K.M., A.W.K.), Critical Care Medicine (A.W.K.), and Regional Trauma Program (C.G.B., A.W.K.), Foothills Medical Centre, Calgary, Alberta, Canada; University of Aberdeen (I.C.), Aberdeen, Scotland; Northside Hospital Forsyth (M.B.), Cumming, Georgia; University of Pennsylvania (N.P.), Philadelphia, Pennsylvania; New York Methodist Hospital (L.M.), New York, New York; Institute of Clinical Physiology (L.G.), National Research Council, Pisa, Italy; and World International Network Focused on Critical Ultrasound Secretariat (C.G.), Bologna, Italy.

Original Abstract:  http://www.ncbi.nlm.nih.gov/pubmed/22182864

There has been a recent growth in the range of medical and surgical treatments available in cosmetic dermatology.

The second edition of Color Atlas of Cosmetic Dermatology was originally written to provide a succinct yet broad overview of cosmetic therapy using a range of illustrations and photographs – an area where devices like the iPhone and iPad really shine.

Targeted at a niche group of healthcare providers, this app certainly gets the job done. Valuable information covering consultation, management, treatment and side effects of cosmetic procedures has not been lost in this transfer from physical book to electronic app.

From the contents page of this universal app, it is possible to access information related to 64 specific conditions/diseases which come under various headings including disorders of various glands, hair follicles, pigmentation, photoaging, vascular alterations and benign/malignant growths. This comprehensive reference is well designed ensuring relevant information can be found quickly and efficiently.

Each particular condition is consistently presented in the same fashion and includes important information such as pathogenesis, pathology, examination, key consultative questions, management and treatment options amongst many other sections. Each section is well presented and accompanied by a wide range of pictures including many illustrating before and after treatment.

Key details on the set-up of each procedure, and a review of the necessary equipment are also provided.

The developers have made an excellent effort to improve the readers experience and this is reflected in an excellent user interface. There are many useful features including a detailed search function, bookmark ability, note-taking and the built in ability to ‘jump’ to a particular section. This ensures that the key information is never more than a couple of taps away-a key point for any detailed reference texts such as the Color Atlas of Cosmetic Dermatology.

The color photographs have also been ‘tagged’ so they also show up in search results which is useful as dermatology is so reliant on visual inspection and examination. Color Atlas of Cosmetic Dermatology contains over 450 high resolution color photographs which can be manipulated using standard touch gestures.

One particular strength of this app is the inclusion of detailed bibliographies at the end of each section. These correspond to the end of chapters in the physical text and it is nice to see the inclusion of these in the app. This allows the end user to review the evidence for themselves and assess the risks and benefits of various treatments.

Price:

• $139.99

Likes:

• Lots of detailed color photos
• Excellent user interface for a textbook
• Evidence based references
• No internet access required
• Universal app

Dislikes/Future Updates I’d Like To See:

• It would be fantastic if the detailed references at the end of each section were linked to PubMed or Google so it would be easier to access the original papers.

Overall Rating:

• Color Atlas of Cosmetic Dermatology is an excellent reference resource for dermatologists who are looking for a complete yet concise guide to a wide range of cosmetic disorders
• The user interface is focused and presents information covering diagnosis, treatment, and procedures in an easily accessible format
• Whilst expensive, the price is comparable to the physical version.

iTunes link

In 2011 we did a review of the first interactive medical textbook, reported on major investments by mainstream publishers in digital platforms, and wrote extensively on the the distribution of iPads and other tablets to medical students, residents, and physicians.

Here at iMedicalApps we are always interested in ways to utilize mobile technology for a positive purpose — changing the way that healthcare professionals are trained certainly falls into that category.

CourseSmart offers a huge range of online digital textbooks which are easily accessible on a range of devices. We have previously introduced CourseSmart and recently reviewed the platform, concluding with some mixed impressions. We also had a chance to talk to CourseSmart’s Chief Marketing Officer, Jill Ambrose and ask her a few questions about CourseSmart and get some insight into the transformation of medical education.

Please tell us a little bit about the background and initial founding of CourseSmart

CourseSmart was founded in 2007 when a group of six higher education publishers partnered together to offer faculty a textbook evaluation service and students a new choice for buying and accessing their required textbooks online. The publishers included Pearson, Cengage Learning, McGraw-Hill Education, John Wiley & Sons, Houghton Mifflin and Bedford, Freeman and Worth Publishing Group (Macmillan).
Today, the company is recognized as the world’s largest provider of eTextbooks and digital course materials with more than 30 higher education publisher partners and over 20,000 eTextbooks and eResources available to our 2.5 million users.

What is the vision for CourseSmart as a company?

Our vision has always been to expand access to higher education and improve learning outcomes by connecting content producers with content users in the higher education space and offer:

• significant savings
• device agnostic access both online and offline
• superior reading experience
• advanced app technology
• unmatched campus integration.

The way in which students and faculty are consuming course materials is changing rapidly and we pride ourselves in staying ahead of these trends. We have a long list of industry firsts that include the first iPhone app in August of 2009, the first iPad app in April of 2010 and the first Android app in April of 2011, and the first mobile web app last month among others. We are continually enhancing our offering across all platforms and devices that connect users with our content.

CourseSmart has an enormous range of titles available-could you elaborate on the process by which titles are selected and transferred to electronic form?

We believe content is critical and a main differentiator between us and many of our competitors. How important is your offering to students if they can’t get the titles necessary to pass the class?

We rely on our publisher partners to provide the most current course materials in use today to ensure students are able to find their required course materials in digital form and can take advantage of all of the digital efficiencies that accompany our eTextbooks, including guaranteed, upfront savings of up to 60% when compared to print textbooks, anytime, anywhere access via any computer or web-enabled device, as well as the ability to “cache” their eTextbooks for usage offline. Our expertise in this end to end workflow allows us to obtain the content in a PDF file along with various metadata associated with the title. Our proprietary system manages the content ingestion and publishing processes so that students and faculty alike can find what they need quickly.

The reviews on iTunes of your CourseSmart iPad app seem largely negative with criticism directed toward a lack of multitasking, the repeated sign-in and a number of other issues. Do you feel that these reviews are justified?

Being the first to market with apps for the iPhone, iPad and Android, we have blazed the trail for many followers in the industry. Being first often means you have to anticipate the best features before the device is even in the market such as the iPad app. We get many of them right and listen carefully to our customers.

We take all feedback into account as we develop the next iterations of our mobile offerings to ensure we have the best offering on the market. The rating on each version of the iPad app is higher than the former version demonstrating our commitment to continuous improvement. As we develop features to satisfy our customers’ needs, new feature needs arise. The requests that you are seeing in the reviews today are currently being evaluated for future development. We continuously strive to enhance our offerings to remain the top destination for accessing digital learning materials.

Has CourseSmart linked up with any medical schools to integrate technology and learning?

CourseSmart has partnered with hundreds of institutions to offer a comprehensive solution across a broad range of disciplines, and we have worked with several medical schools that now offer digital course materials specifically for their medical programs. As background, CourseSmart’s eTextbook platform can integrate with an institution’s learning management system, student information system or campus portal, enabling faculty and students to integrate their digital course materials directly into their workflow.

Where do you see the future of medical education?

Like the rest of the higher education industry, I believe many courses taught outside the lab or hospital will move online, offering flexibility to students. In addition, simulations and interactive learning will provide additional practical learning environments for students. Real time mobility of information will be a source for learning while in medical school with applications that will extend into future examination and operating rooms.

What does the future hold for CourseSmart?

We at CourseSmart will continue to innovate and provide a robust offering for the devices and platforms that are most in demand. The continued proliferation of Web-enabled mobile devices and campus WiFi will drive eTextbook and other digital materials growth. We will also see the growth of course materials with integrated assessment and automatic feedback for students (eResources) as they are utilized to improve learning outcomes.

Is there anything else you feel our readers should know about CourseSmart?

CourseSmart’s primary goal has always been to connect content providers with content users at the lowest cost possible in an effort to increase access to course materials and improve learning outcomes.

While eTextbook adoption is growing rapidly, many students still prefer print textbooks and this makes page fidelity crucial. CourseSmart enables all students, whether they are using a digital or print edition, to literally be on the same page. Further, CourseSmart’s eResources provide students with engaging experiences that result in higher learning outcomes. It’s not just about what’s “fun and interesting” in their eTextbooks but rather, what truly helps them to engage and ultimately, the comprehension of that learning experience.

Coursesmart Website

Many university providers and educators around the world have embraced digital course materials in order to supplement existing course materials. Many now aim to go beyond merely distributing PDF notes or making lectures available online and use platforms like the iPad to teach medicine in new ways.

CourseSmart, a venture founded in 2007 and supported by many leading publishers, aims to provide eTextbooks and digital learning tools to students across America. CourseSmart is one of the largest provider of digital course materials and their catalog includes over 90% of the core textbooks in use today by North American Universities.

CourseSmart’s business model is based around providing easy, instant access to a vast range of texts. They have signed up an impressive number of publishers including Pearson, McGraw-Hill, Elsevier, John Wiley & Sons, Macmillan, Lippincott, Wilkins & Williams amongst many others. A quick search of their medical section revealed over 190 texts purely in the medicine category.

It is straightforward to search for and add a text to your ‘cart’ which subsequently becomes your ‘bookshelf’ once you have paid for your book. Interestingly, CourseSmart works on an annual rental basis so the user is essentially paying for one years worth of access to a specific title.

The additional eResources provide a variety of digital content and tools created for the end user and include:

• Links to other websites for content associated with a particular course
• Online quizzes or exercises
• Simulations and online videos

CourseSmart also partners with institutions to try and integrate their digital materials into the specific course, “thereby improving productivity and performance for students and instructors alike.” Students can access the eTextbooks via the web or on a range of mobile devices such as the iPad, iPhone and Android. The web reader boasts an impressive interface including the ability to annotate, highlight, search, copy, share and print.

The actual eTextbooks are high quality scans of the original books and easy to navigate. One aspect which is useful is the fact that CourseSmart eTextbooks maintain the valuable aspects of the print textbook including page numbers and page layout thus enabling students to quickly and easily switch between physical and electronic versions. Student are also likely to be pleased with the monetary savings available due to the fact that CourseSmart tests cost on average, 60% less than a printed textbook (source).

CourseSmart has certainly put their stamp on the particularly exciting development of online textbooks and resources. The wide range of medical textbooks available and ease of accessibility are sure to help ensure CourseSmart become a popular resource for both students and educators. CourseSmart enables instructors to be more productive and facilitates instant access to essential learning materials for students.

Stay tuned for a review of the CourseSmart system in action, an interview and a comparison between CourseSmart and their competitors.

Link: Coursemart

by: Matthew DiPaola, MD

Dr. DiPaola is an orthopedic surgeon who specializes in shoulder and elbow disease. We appreciated his contribution to iMedicalApps.

The Shoulderdoc app is the accompanying app to Shoulderdoc. This website is every shoulder surgeon’s guilty pleasure. It contains more information on shoulder surgery and treatments than one can find in one place on the web.

Shoulderdoc is the brainchild of Dr. Leonard Funk, a specialist shoulder surgeon in the UK. Dr. Funk has spent the last decade feeding his main website with a plethora of useful shoulder related content. I like the concept of having a “go to” shoulder site where I can quickly find all of the latest feeds of articles, patient education topics and latest trends. I’ve always found the site to be updated frequently, the content to be good and referenced well. I do have a few hang-ups about the site, though.

The site has a ton of information but it’s a bit crowded, full of ads and sometimes hard to navigate. Also, some of the menu text is in orange print which is difficult to read. So is the app just a mini shoulderdoc website? The answer is no.

The layout of the mobile app is smooth and easy to read – light orange and white backgrounds with black lettering for the most part. Unlike the main website, the app’s main audience is patients. Put simply, the app condenses a host of patient education materials found on the main website in a manner that makes it quick easy to access. If you are a surgeon, you may be a bit bored with the app.

You won’t find the latest RSS feeds from the main shoulder and sports medicine journals or detailed classification systems in the app. These are things that I like about the main site. But then again, I am (usually) not a patient.

I trialed the app on the iOS platform – iPad and iPhone. The bottom menu contains 5 categories “topics, diagnose, your surgery, videos and a brief about us” page. The “Topics” tab at the bottom left is a repository of about 30 different shoulder conditions.

Topics range from rotator cuff tear, biceps problems, and calcific tendonitis, to injections, labral tears and nerve disorders. You will typically encounter a second menu of more specific categories of the main topic after you click on one from the main menu.

For example, when you click on AC Joint Problems you encounter a submenu of: AC joint, AC Joint Osteolysis, ACJ Arthritis and ACJ Dislocations. Clicking on one of these subheadings will then take you to a nicely laid out summary of the problem usually accompanied by a drawing to help illustrate the condition. Within the sub-menus there are usually some treatment options. So patients have a quick reference for not only the problem but some common treatments. The content seems appropriate and would likely be helpful for most patients.

The “Diagnose” tab comes up next. It links to an interesting tool that takes you through a series of questions and helps you develop a preliminary “diagnosis” of your shoulder problem. The patient completes the algorithm and is given a brief link to information about their likely problem at the end.

The disclaimer shows that this is a “rough guide” to help you find more information about your shoulder. You need a full medical exam to get an exact diagnosis.

The “Your Surgery” section answers many common questions about what one’s surgery will be like. Certainly, some of the items are tailored more toward Dr. Funk’s personal practice so it may not be completely applicable to every shoulder surgeon’s practice, but there is a lot of good general information.

At the very least, a shoulder surgeon might do well to use some of Dr. Funk’s information as a general outline to help guide patients through their experience.

“Print Booklets” took me to the “Shoulder Store” on the main web site where there were books and slings for sale (all in British Pounds). I was expecting a link to printable information packets for patients. Dr. Funk has put together a 44 pg booklet for 7.99 that covers “everything you need to know” about the process of undergoing shoulder surgery.

I have not read his book so I do not know how much of that same information is in the app. But since it looks like a lot of information is in and you can get it for free, it’s to your advantage to go digital.

The “Videos” tab take you to 2 categories labeled “shoulder animations” and “”surgery animations.” There were a series of videos in the “shoulder animations” section. The shoulder arthritis video did not play, but others did. They were about 3-5 minutes each and consisted of Dr. Funk standing in a lecture format guiding users through a series of animations on various problems.

The surgery animations were cartoonish videos that nicely illustrated some common procedures. They were easy to understand, well annotated and would likely not turn off the squeamish who may not like real videos with blood.

The “about us” tab states that all content is written by medical professionals and reviewed by Dr. Funk (and tells one how to get in touch with their clinic for a consultation).

Likes:

• Layout was simple and standardized. When you navigated through the links you knew what to expect
• Videos were concise
• Information seemed pertinent and comprehensive

Dislikes:

• Perhaps as time goes on and these app reviews get more plentiful, we’ll see small labels come up next to the app stating the appropriate audience. This app is geared more toward patients than any other audience.

UpToDate today announced the release of UpToDate MobileComplete, a new version of its recently released app that brings its 9,000 topic articles and 23,000 graphics to the iPhone.

This familiar resource mades its debut in the mobile world this summer and has already been downloaded by over 42,000 clinicians.

When we reviewed UpToDate Mobile in August, Dr. Amit Patel’s conclusion was pretty simple,

“You can bet that this UpToDate App will make the next edition of our Top 10 Apps for Internal Medicine Physicians”

One of our complaints though with the app was occasionally slow load times for some topics, a consequence of having to pull the content over a WiFi or 3G connection. MobileComplete addresses that complaint, but at a cost. While its not clear how much memory the app will use, the desktop software uses 2GB and we can certainly expect a similarly hefty demand by MobileComplete (Update: The local app, MobileComplete, will require 300MB of memory for text content and 1GB for text and images. Thanks to Vicki Brown for that info).

Now, however, physicians and other healthcare providers who use UpToDate will have a choice – and given the number of users, the way they choose between the two may give us some interesting insight into the relative demand for cloud-based apps vs. local apps.

Many of our favorite apps have had to decide between the two approaches, with CORE going to route of cloud storage of some of its more data-intense content, whereas Modality chose to go with local storage for its Procedures Consult apps. The former approach relies on pretty consistent 3G/4G access or WiFi access. It will be interesting to see the extent to which MobileComplete is adopted – given the sheer number of healthcare providers using UpToDate, it may give us some insight into how connected healthcare providers really are.

The app itself will cost a subscriber an additional $49, a cost I suspect that users in areas of poor 3G connectivity or limited WiFi access will find well worth it. Institutional subscribers still have to wait however, as a mobile app for us is not yet available – a consequence of the customization institutional subscribers often require, according to Vicki Brown (VP, Marketing, UpToDate).

Nonetheless, the continued move to mobile by UpToDate is certainly one that will be welcomed by countless physicians, residents, interns, medical students, nurses, pharmacists, and pretty much every other healthcare provider out there.

Check out our full review here!

Scosche MyTrek is a Bluetooth enabled armband and wireless pulse monitor. It is a comfortable workout tool for managing pulse, training type, calories burned and more using a complimentary iPhone/iPod app and a great example of the emerging consumer market in the new mobile paradigm  of ubiquitous computing.

I believe the “self-quantifiers” are among the least understood and under appreciated market. Courting this early adopter customer is going to be key for developers of mobile fitness and health monitoring peripheral devices.

MyTrek utilizes two LEDs combined with a photo sensor to detect minute changes in the user’s blood pressure to accurately measure pulse. A built-in accelerometer allows MyTrek to adjust for movement during exercise from the user’s heartbeat allowing for an extremely accurate measurement of pulse and calories burned.

The device uses a lithium ion battery, which provides five hours of continuous workout time before the MyTrek needs to be charged with the included USB cable.

Users can set goals and monitor their track record passively and receive alerts either congratulating or following through and achieving those goals. The device also includes a motivational voice which guides you through your workout and helps keep you in your training zone.

Another cool feature that should help the MyTrek device gain traction is the incorporation of buttons on the device which allow users to control the music while they workout without having to pull out the device itself.

The device itself costs $129.99 online at Scosche.com or at participating Apple retail stores, 24-hour Fitness gyms, Target and Verizon Wireless stores. You can download the complimentary iPhone app for free at the App Store.

Other devices competing with the MyTrek for the consumer fitness wireless pulse monitoring space include Body Media, and Zephyr Technologies.

See a promotional video for the MyTrek device below.